Archive for the 'Science and Medicine' Category

This is an ongoing story that isn’t over yet. As it has been raging for days now, most people have probably heard that there is a big measles outbreak starting in Disneyland in California. There are now 87 confirmed cases of measles, 50 of which can be directly linked to Disneyland. Of the 42 people so far whose vaccination status is known, 34 were unvaccinated, 3 were partially vaccinated, and 5 were fully vaccinated.

Yes, this is caused by those who are not vaccinated

One thing is absolutely certain from these numbers – this outbreak has largely been caused by those who are not vaccinated. As you can see, most of those affected are unvaccinated. The vaccination rate for MMR is about 90% in the US. This means those who are unvaccinated were about 67 times more likely to be infected with measles in this outbreak than those fully vaccinated.

If vaccination rates were higher, then herd immunity could have stopped or severely limited the spread of the disease. That is the point of herd immunity – if enough people are protected then the virus is less likely to find a vulnerable host and continue the spread. The vaccine is about 97% effective in those fully vaccinated, which is why there were a few vaccinated people who contracted the disease.

Humans have a massive footprint on our ecosystem. Enough so that we have to think carefully about anything we do on a large scale, such as agriculture, industry, shipping (because of invasive species), and using drugs to fight bacterial infections.

The development of antibiotic resistance is a particular worry of mine, and one that I feel does not get proportional attention in the media. It is quite possible that in the future more people will die from antibiotic resistant bacteria than global warming, food shortages, or disrupted ecosystems (depending on how each of these things develop).

We are already seeing more deaths from drug-resistant bacteria, longer hospital stays, and greater costs. I have seen this change during my career. When I round in the hospital I now have to don protective garments before entering many patient rooms because they are infected or even just colonized with a resistant strain of bacteria.

There is no way around the fact that were are engaged in a war with the subset of bacterial species on this planet that are capable of infecting humans. We have been winning for a while, but the bacteria are now rallying.

This is one of those glass-half-full / glass-half-empty news items. Different headlines reporting on the same study present the results in opposite ways. The BBC, for example, writes, “Life choices ‘behind more than four in 10 cancers.’” Meanwhile the press release from Johns Hopkins states, “Bad Luck of Random Mutations Plays Predominant Role in Cancer, Study Shows.”

The Hopkins headline is more accurate. The BBC headline is not just focusing on life choices vs bad luck, it actually gets the data wrong.

What the researchers did was look at the replication rate of stem cells in different tissue types (they did not include breast cancer and prostate cancer as they could not find published replication rates). They then compared differences in these rates to differences in adult cancer rates in the same tissues. For example, colon cancer is more common than cancer of the small intestine, and colon cells replicate more frequently than small intestine tissue. (In mice, this is reversed, but the correlation holds.)

Fad diets pop up on a regular basis. I believe that is because they are so easy to manufacture and there is a ready made market for them. Add to that the fact that it is difficult to lose weight. There is also a great deal of misinformation out there about diet and health, so the environment is very friendly to pop pseudoscience.

If you want to create your own fad diet, here is a handy formula. These things pretty much write themselves.

#1 – You need a catchy title, usually taking the form of “The blank Diet.” You can fill in the blank with almost anything. For example, a recent fad diet is called “the bulletproof diet.” This doesn’t say anything about the diet itself, it’s just a catchy phrase, a brand. You can fill in the blank with a title that does reflect the diet itself, but this is optional. Creating a catchy title is actually the most creative work you have to do in making a fad diet.

I have been saying for several years that if there is a pseudoscientific medical treatment that is especially vulnerable to critical analysis it’s homeopathy. There’s a lot of nonsense in the world of medicine, but homeopathy takes the prize. First, it is complete and utter nonsense.

There is no need to equivocate. Homeopathy violates basic scientific knowledge in physics, chemistry and biology. It is transparent witchcraft that cannot possibly work by any known or even semi-plausible mechanism. Further, clinical studies unsurprisingly show that it does not work, for anything.

And yet the public does not generally understand what homeopathy actually is. The most common belief is that homeopathy is natural or herbal medicine. Rather, homeopathy is based upon several dubious notions. The first is that like cures like, and idea based on sympathetic magic and not science or any knowledge of the real world. Further, the actual starting ingredients are based upon a fanciful and often absurd interpretation of this dubious notion, leading to things like using duck liver to treat the flu.

None of this actually matters, however, because most homeopathic remedies are diluted beyond the point that there is any chance of a single molecule of starting ingredient remaining. All of this is supposed to work, however, because the potion is “activated” by shaking it.

New evidence suggests that strains of the bacterium, Bordetella pertussis, which is responsible for whooping cough, may be evolving to evade immune protection afforded by the pertussis vaccine.

The research, led by Dr Andrew Preston from the University of Bath, evaluated surface proteins from the 2012 whooping cough outbreak. They found that surface proteins that are included in the acellular pertussis vaccine were evolving faster than surface proteins not included in the vaccine. The authors point out that this was happening even prior to the introduction of the vaccine, but has accelerated since the vaccine.

It is not yet clear what, if anything, this means for the effectiveness of the acellular pertussis vaccine. However, the concern is that circulating strains of B. pertussis will continue to evolve, diminishing the protection provided by existing vaccines.

Whooping cough is a potentially serious illness, primarily affecting infants. There was an outbreak in the UK in 2012 with 10,000 confirmed cases and 14 infant deaths. In the US that same year there were over 48,000 cases reported (not necessarily confirmed) and 20 deaths.

An Australian based company called Universal Medicine (UM) has been criticized by various skeptical blogs and groups as being a new age alternative medicine cult. Looking through their website, this seems like a reasonable observation. (The term “cult” is fuzzy, but many of the features seem to be present.)

In response to this criticism, UM has apparently issued many complaints to Google, claiming defamation. According to the site Chilling Effect, Google has responded at least in some cases by removing the sites from Google searches, effectively censoring those websites.

This type of action represents a serious threat to the skeptical mission. Part of that mission is consumer protection, and the primary method of activism is public analysis and criticism of dubious claims, products, services, and organizations. Essentially, we expose charlatans.

Charlatans, it turns out, don’t like to be exposed. They don’t like bad press.

On the desk of New York Governor Andrew Cuomo is a bill that would protect doctors practicing substandard medicine from being investigated by the Office of Professional Medical Conduct. The bill is similar to one unfortunately passed in Connecticut a few years ago – it is meant to protect doctors who prescribe long and recurring courses of IV antibiotics for alleged chronic Lyme disease.

This would be a terrible law on many levels, and I urge Governor Cuomo to veto the bill.

Bad Law

The standard of care in medicine is determined by the consensus of medical opinion and practice, which in turn is based upon the best available evidence. Often this is informed by panels of experts and professional societies who review the evidence and publish practice guidelines or standards.

The standard of care cannot be written in stone because it is a moving target. Scientific evidence is a living changing thing, and so you cannot simply write into law what the standard of care is. Rather the law simply sets up a process by which the standard of care can be determined when necessary.

Water is the focus of a great deal of medical myths and snakeoil. This is perhaps due to water’s health halo – it is the very essence of purity, the elixir of life. I wonder if there is an evolved psychological connection to water. The idea of drinking dirty or contaminated water seems to be especially disgusting, while pure clean water is the most wholesome thing in the world.

Perhaps this is why there are so many “magic water” scams out there. There is structured water, energized water, and ionized water. Homeopathy is essentially magic water with memory.

There is also a persistent belief that simply drinking more water has untold health benefits. You have probably heard that you should drink eight 8 oz glasses of water per day to stay healthy. This, however, is a myth, in that the 64 oz figure is not based on any evidence.

Your water requirements will vary, depending upon your body size, level of activity, humidity and ambient temperature. It will also depend on the type of food you eat. We get on average about 20% of our water intake from our food, but this will also vary depending on the type of food you eat.

I wrote recently about an 11-year-old girl, a member of Canada’s Six Nations community, who has leukemia. Her parents, concerned about the side effects of chemotherapy, would rather treat her with traditional and alternative medicine. They are fighting for their right to do so, and the court seems sympathetic to the rights of the parents to express their cultural identity.

Meanwhile, it seems clear to me that the parents, and more importantly the girl, are simply being victimized by a charlatan, who has nothing to do with their cultural identity.

The seduction, really a con, is fairly straight forward. A seriously ill child is every parent’s worst nightmare, putting them into an extremely vulnerable position. Cancer is especially frightening, and chemotherapy, while it can be effective, is harsh. Leukemia is very treatable, and the girl’s doctors give her a 90-95% chance of being completely cured with a standard course of chemotherapy. However, she will have serious side effects from the chemo, and that is hard for any parent to watch. It can be an emotional dilemma (I think intellectually it’s a no-brainer, but emotionally tough).